Present: Mr B Reid OBE Chair of the Board of Directors Mr N Summers CBE Vice Chair of the Board of Directors. Mr G McEvoy Non-executive Director

Transcription

1 ENC 1 MINUTES OF THE TRUST BOARD OF DIRECTORS OF WALSALL HEALTHCARE NHS TRUST HELD ON THURSDAY 25 APRIL 2013 AT 2PM IN THE MANOR LEARNING AND CONFERENCE CENTRE, WALSALL MANOR HOSPITAL Present: Mr B Reid OBE Chair of the Board of Directors Mr N Summers CBE Vice Chair of the Board of Directors Mr S Gray Non-executive Director Mr G McEvoy Non-executive Director Ms D Oum Non-executive Director Mr R Cooke Non-executive Director Mr R Kirby Chief Executive Mrs J Tunstall Chief Operating Officer (minute 94/13 onwards only) Ms S Hartley Director of Nursing Mr A Khan Medical Director In Attendance: Mrs D Clift Mrs A Baines Mrs C Balachander Mr R Caldicott Director of Governance and Trust Secretary Director of Strategy Director of Post Graduate Medical Education (Minute 93/13 only) Deputy Director of Finance Apologies: Mr K Mansfield Interim Director of Finance & Performance 83/13 DECLARATIONS OF INTEREST ACTION There were no declarations of interest. 84/13 PATIENT STORY Mrs Burnell presented her experience of receiving maternity care in the hospital. She praised the pre natal care received. Her labour was long and it culminated in an emergency caesarean. She was left alone in labour in the middle of the night and despite calling in pain, the midwives failed to offer support. The following day, the care improved. The care in theatre was noted to be exceptional but post natally she considered the care to be poor. Mrs Burnell said that the attitude of two 25 April 2013 v.1 For One and All 1

2 midwives had left her in distress after discharge. A formal complaint was therefore made. Mrs Burnell felt that the complaint had been handled exceptionally well, to the point where she would consider having another baby at the Manor. Mr Reid thanked Mrs Burnell for presenting her experience, especially given the difficulties that she had encountered. Mr Kirby advised that lessons learnt resulted in referral of some individuals for supervisory mentorship, two members of staff had left the Trust and the case of Mrs Burnell had been used as a learning and educational case study within the Trust. Mrs Hartley offered to facilitate a visit back to the maternity ward for Mrs Burnell if she felt this would be helpful. Mr Reid asked Mrs Burnell if there was anything further that the Trust could do to assure her that they had taken her experience seriously. Mrs Burnell stated that she felt confident and assured from the action taken by the Trust and thanked the Board for listening and responding to concerns in a speedy and professional manner. 85/13 MINUTES OF THE TRUST BOARD MEETING HELD ON 28 MARCH 2013 The minutes of the meeting held on 28 March 2013 were agreed as a correct record. 86/13 MATTERS ARISING AND LIVE ACTION SHEET The Board noted and agreed the content of the live action sheet. With regard to the Expert Patient Programme, Ms Hartley confirmed that a verbal update would be presented to the Trust Board in May SH May /13 CHIEF EXECUTIVE S REPORT Mr Kirby delivered the monthly Chief Executive s report and congratulated the Trust on its achievement of the end of year position in a position of challenging capacity pressures. An overview of the Mortality Review commissioned by Walsall Overview and Scrutiny Committee was delivered. It was noted that the report developed by Mott MacDonald was now published and had been considered by the Overview and Scrutiny Committee earlier in the week. The report provided assurance to the Overview and Scrutiny Committee and the general public that improvement actions taken within the Trust to reduce mortality levels are appropriate. Recommendations for further improvement in the areas of Urinary Tract Infections and speedier discharge process were accepted and the Mortality Review Group would now be taking forward clear actions 25 April 2013 v.1 For One and All 2

3 to address these areas of improvement. A report detailing the progress made by the Trust is reducing mortality over the past 12 months would be presented to the Trust Board in June AK June 2013 Mr Kirby highlighted the significant pressures on staffing and capacity within the A&E Department and confirmed that a focussed piece of work was now on-going to make a range of improvements to the service. It was noted that the Quality and Safety Committee would be governing improvements through the governance structure. With regard to Board composition, it was noted that interviews for the Director of Finance and Performance had taken place on 22 April 2013 and that Mr Ian Baines (currently Director of Finance at Dudley and Walsall Mental Health Trust) had been appointed into the post. Negotiations regarding the start date for Mr Baines were on-going. In addition, it was noted that Mr Stuart Gray would be leaving the Trust Board at the end of April 2013 to focus on fundraising and charitable funds for the organisation. Vacancies for two Non-executive Director posts had now been published and the recruitment process continued. The Board noted the content of the report. 88/13 FOR ONE AND ALL PLAN 2013/14 Mr Kirby presented the plan detailing key actions to be taken in 2013/14 to embed the For One and All Organisational Development Programme. It was noted that the first colleague connect event had taken place the previous evening to encourage staff to give their views on things the Trust needs to do to improve the colleague and patient experience. The aim was to produce a schedule of the top 10 improvement areas from this exercise at the end of June It was noted that one action from each event would be implemented immediately. The event from the previous evening had generated an immediate action relating to the purchase of drip stands for each ward. Mr Reid asked that all actions and requests for change/improvement were logged for presentation to the Board in future reports. This was agreed. RK Mr Summers made reference to pilot improvement workstreams that had taken place in A&E, Ward 10 and community services. Lessons were now to be adopted regarding coaching, leadership and empowerment of teams to support a culture change of positive thinking, organisational learning and belief in change. Mr Summers felt that some of the timeframes associated with the leadership aspects of the For One and All Plan were too generous and that some of these should be expedited. He also felt that staff engagement was a very pressing issue which required more prioritisation in the plan. 25 April 2013 v.1 For One and All 3

4 Mr Kirby accepted these comments and agreed that there were some points of emphasis that need strengthening as a result of the TMI improvement work that had been on going in the Trust and agreed to amend plan. In terms of governance structures, it was agreed that in future, monitoring would take place at the Performance Finance and Investment Committee on a monthly basis with quarterly progress reports to the Trust Board. Subject to the above adjustments, the Board APPROVED the Plan for 2013/14. 89/13 NATIONAL INPATIENT SURVEY RESULTS 2012 Mrs Hartley presented the National Inpatient Survey results for 2012 for the Trust. It was noted that a 45% response rate had been achieved from a number of patients receiving inpatient care in July Results had been generally sustained in accordance with the previous year. The Trust was now ranked nationally at 105/161. It was noted that the Trust had made improvements in the questions relating to single sex accommodation and nurses talking in front of you. Areas where performance had reduced related to privacy in A&E, the length of time patients were waiting on a waiting list and visibility of how to complain. Improvement actions in all of these areas were now being implemented. Mr Reid asked Mr Khan to comment on the disappointing trend relating to communication between Medical Staff and patients. Mr Khan confirmed that a training and education programme was now in place with Doctors to improve communication techniques. Mr McEvoy asked for clarity on the lead Director for taking forward the improvements in the survey. Mr Kirby confirmed that the actions to address issues were included in the For One and All action plan which would be tracked through the For One and All Steering Group. Mr Kirby stated that given the challenges that the Trust had faced in relation to capacity pressures, he was comfortable with results for 2012/13. The Board was reminded that a replica survey would take place in May 2013 which would give a view of progress against the improvement actions. The Board resolved to note the actions contained in the report. 90/13 THE EQUALITY DELIVERY SYSTEM 25 April 2013 v.1 For One and All 4

5 Mrs Hartley presented the report which had been compiled following the outputs of the lay assessment process. This demonstrated strong correlation in self assessments and lay assessments. Where variations occurred, this related to the availability of evidence to the assessors at the time. Mr Reid requested clarity on the content of appendix 2 to the report. Mr Kirby advised that these related to the locally determined objectives for EDS aligned to the four national goals. Mr Reid asked for confirmation of the timeliness and monitoring of performance to improve EDS. Mrs Hartley advised that she had not yet determined a timeframe for monitoring and achievement of goals. Mr Reid urged that this was completed. The Board requested an update report in July Mrs Baines asked if there was an intention to align this more closely to strategic and workforce planning so that the organisation can reflect its commitment and actions relating to EDS in the 5 year Integrated Business Plan. Mrs Hartley confirmed that this was the intention. Ms Oum reinforced the need to own and understand EDS and make this part of the culture of the Trust and the need to periodically review systems for delivering the project to ensure maximum effectiveness. SH July 2013 The Board resolved to NOTE the content of the report 91/13 ENHANCING DEMENTIA SERVICES Mrs Hartley presented the report which included an overview of local demographics, actions to improve Dementia services locally and an appended Strategy for Dementia services. It was noted that there was a growing local population at risk or diagnosed with Dementia who would benefit from service improvement in this area. She presented the Strategy for driving forward Dementia in Walsall, including screening, signposting, the shaping of services and pathways, innovative staffing models and close working with experts in the third sector. The Board were advised of environmental improvements that had taken place in the organisation to develop a dementia friendly environment including the use of coloured crockery etc. In addition, a range of therapeutic services had been developed including beauty therapy for patients, patient massage and the kissing it better programme. It was noted that Ward 4 and Ward 9 have been chosen to commence roll out of the Strategy. Ms Oum stated that the Dementia Strategy represented a long period of development time through the Older People s Group and that the explicit outcomes of the Strategy and KPIs would be developed in the near future. Mr Summers considered that the report should be 25 April 2013 v.1 For One and All 5

6 enhanced to address the opportunities that integration brings to enhancing Dementia Care. He suggested that the vision should include addressing the needs of patients and their families in their own homes. Mr Kirby referred Mr Summers to page 9 of the report which explored a range of integration opportunities. Ms Oum advised that the Strategy primarily focuses on patients with medical issues with a diagnosis of Dementia, rather than Dementia across the wider community. Mr Cooke stated that he would welcome a greater understanding of the volume of patients with Dementia together with future anticipated growth so that we can ensure that the Strategy is adequate to meet projected needs. This was noted. The Trust Board resolved to:- Note the content of the report Approve the Dementia Strategy 92/13 EVALUATION OF THE WINTER PLAN Mr Kirby presented the paper in the absence of Mrs Tunstall. The key observation was that the Trust had been better prepared for Winter in 2012/13 than in previous years and that most of the plan worked well. It was noted that the Plan had been significantly tested through unforeseen challenging increases in the demand for services which exceeded that seen in previous years. This meant that there were periods when the pressure on capacity stretched the organisation and impacted on use of bank and agency staff, bed availability and discharge arrangements. The Board agreed that for 2013/14 an increased focus on stress testing of the plan was required so that there was a better understanding of the activity threshold that the plan can cope with, with contingency measures for implementation if activity exceeds these levels. A second lesson learnt related to the opening and closing of extra capacity to flex in line with activity pressures, which can impact on the quality and safety of care, and in turn the patient experience. The Board had therefore taken the decision to keep wards 12 and 14 open sustainably through 2013/14 to assure quality and safety outcomes. It was agreed that there was a need to get the baseline bed capacity right so that physical and workforce capacity can be accurately aligned, with some headroom for escalation measures. Mr Kirby advised that this matter had been debated at the Quality and Safety Committee and that a demand and capacity assessment would be presented to Committees and the Trust Board in May JT/KM May 2013 Mr Khan felt that unprecedented levels of pressure had been encountered in the Winter of 2012/13, coupled with increased activity from the mid Staffordshire population. He felt that whilst the 25 April 2013 v.1 For One and All 6

7 organisation coped with this pressure there were a number of lessons to be learnt as described above. He also considered that the Medical Workforce review needed to be embedded further to enhance consultant presence at the frontline and regularity of ward rounds. Ms Hartley felt that during 2013/14 there was a strong need to focus on integration to relieve pressure in the acute environment including the alignment of pathways and workforce models across hospital and community. Mr Reid commented that this was the fourth Winter Plan developed by the Trust. The Board considered was a very comprehensive plan and was the best seen to date in the organisation and complemented colleagues at all levels for effective delivery. The Board requested that their appreciation be formally expressed to all colleagues for the delivery of the plan in a very challenging environment. With regard to 2013/14, it was agreed that the first draft of the Winter Plan would be presented to the Trust Board for debate in July The Board resolved to:- Note the content of the report Receive the demand and capacity assessment for 2012/13 at the May 2013 Board meeting Receive the first draft of the Winter Plan for 2013/14 at the July 2013 Board meeting JT July /13 DEANERY REVIEW Mr Khan presented the report and was joined by Mrs Balachander as the Medical Education lead for the Trust. The paper highlighted the findings of a total of 4 Deanery visits that had taken place across the Trust. Some positive aspects had been identified and areas of improvement also affirmed. The areas requiring improvement were noted as follows:- Medicine dissatisfaction with rota arrangements impacting on training opportunities. Limitations on ability for trainees to attend outpatient clinics this was now resolved. Anaesthesia difficulties in appointing middle grades resulting from a national problem reduction of trainees in this area. It was therefore noted that consideration was being given to alternative to provide the care through Consultants rather than Middle Grades. Emergency Medicine physical constraints of the department were of concern, together with the sedation policy in the department and the supervision of some patients in A&E. Mr McEvoy confirmed that a discussion had taken place at the Quality 25 April 2013 v.1 For One and All 7

8 and Safety Committee and advised the Board of the seriousness of this matter and significant risk that the findings presented. It was noted that Compliance with Deanery requirements had been added to Corporate Risk Register and in terms of governance, the Medical Education Committee was now reporting into the Quality and Safety Committee on a monthly basis. Mrs Balachander advised that the next Deanery visit is scheduled to take place on 25/26 June. If the Trust is unable to satisfy the Deanery that they are addressing areas for improvement there was a risk that the Trust may lose trainees with an impact from March The Board agreed that the Trust needed to safeguard current and future trainees and reinforced the commitment given by the Board to implement all improvement recommendations sustainably. The Trust Board requested that the Medical Education Committee present to the assessment of any major risks for the June visit to the Quality and Safety Committee in May 2013 with a verbal update to the Board during the same month. AK May 2013 The Board resolved to:- Note the content of the report Approve the improvement plan Receive a verbal update on the assessment of compliance with recommendations at the May 2013 Trust Board 94/13 INTEGRATION AND IMPROVEMENT PROGRAMME UPDATE Mrs Tunstall presented an update on the delivery of the integration programme and the pioneer pathways. Seven pathways have continued to expand and develop and some are now embedded as part of day to day service delivery. The level of patient and public engagement in the development and evaluation of the pathways was noted to have increased. With regard to other measures of success, Ms Tunstall advised that the Trust was becoming more sophisticated in measuring success and developing appropriate key performance indicators. It was noted that there was external interest in the work being taken forward by the Trust and that the previous day the Kings Fund had visited the Trust as part of the Children Asthma Pathway to accelerate work in this area with completion in September 13. Ms Oum commended the report and questioned what the performance data would tell the Board. Ms Tunstall stated that she had yet to finalise the KPI dashboard, this would however be included and fully populated in the next quarterly report. 25 April 2013 v.1 For One and All 8

9 The Board resolved to:- Note the content of the report Receive a subsequent report in July 2013 including the fully populated KPIs. JT July /13 NHS TRUST DEVELOPMENT AUTHORITY (NTDA) ACCOUNTABILITY FRAMEWORK FOR NHS TRUST BOARDS Mrs Baines presented an overview of the key aspects of the NHS TDA accountability framework which had presented a system of increased rigour and control in the journey to FT, performance delivery and attainment of the Trust s annual plan. It was noted that Mrs Clift, Mrs Baines and Mr Mansfield were meeting shortly to review the requirements of the document in detail so that any impact on systems, governance and reporting could be presented and understood by the full Board. A report on the outcomes of this exercise would be presented to the May 2013 Board meeting. Mr Reid referred to the Board meeting of the NTDA on 26 April 2013 and requested assurance regarding decisions to be taken by the NHSTDA Board relating to the Foundation Trust pipeline. Mrs Baines stated that she had been assured that a decision relating to the timing of all aspirant FT applications would be taken at this meeting and hoped to be in a position to report the outcome to the Board imminently. The Board resolved to:- Note the content of the report Receive a more detailed report on the impact of the framework on the Trust at the May 2013 meeting. AB May /13 BOARD OF DIRECTORS REGISTER OF INTERESTS Mrs Clift presented the Board of Directors Register of Interests for approval. She advised that this had been considered by the Audit Committee the previous day and that a new declaration for Mr Summers was to be added as Director of Sector Marketing Limited. Mr Reid advised the Board that he had recently resigned from the position of Director of Cooperative Financial Services and requested that this amendment be reflected on the register. Mrs Baines declared an interest in her role on the LETB board and it was agreed that this should be added to the Register. The Board resolved to:- 25 April 2013 v.1 For One and All 9

10 Approve the Register of Interests for the Board of Directors subject to the above amendments. 97/13 PERFORMANCE AND QUALITY REPORT Mr Summers presented the views of the Performance Finance and Investment Committee which had considered the report the previous week. It was noted that whilst end of year performance had been broadly strong, challenges had been seen in areas such as A&E, Electronic Discharge Summaries and incomplete pathways for Trauma and Orthopaedics. The Committee had received assurance from the Chief Operating Officer that the Trauma and Orthopaedics incomplete pathways would achieve target levels from April 2013 and that work continued through the Urgent and Emergency Care Improvement Programme to maximise system efficiencies relating to A&E and overall emergency inpatient flow. Mr Summers expressed the disappointment of the Committee in failing to achieve key workforce indicators at the end of the year and noted that these were now to be achieved by the end of Q1 with sustainable performance thereafter. Mr McEvoy stated that Quality and Safety Committee had reviewed the quality indicators in the report and had noted considerable progress in performance when compared to 12 months ago. This was commended against a background of challenging activity levels. It was noted that whilst progress had been made in reducing falls in the hospital, the pace needed to improve further and that an external review from an expert in Falls Prevention and Management had been commissioned to provide an independent report of current practice together with opportunities for improvement. The Trust Board resolved to note the content of the report. 98/13 FINANCIAL REPORT Mr Caldicott presented the report detailing the month 12 finance position. It was noted that this had been considered in detail by the Performance Finance and Investment Committee the previous week. It was noted that all key financial performance indicators had been achieved by the Trust at the year-end including the delivery of the revised forecast surplus totalling 37M. Mr Caldicott confirmed that the draft annual accounts had been filed with the Department of Health on 22 April 2013 and that these had been considered by the Audit Committee at its meeting on 24 April April 2013 v.1 For One and All 10

11 Mr Reid congratulated colleagues on the financial performance of the Trust during a very challenging year. The Trust Board resolved to note the content of the report. 99/13 PROVIDER MANAGEMENT REGIME (PMR) Mr Kirby presented the end March 2013 PMR for consideration and approval by the Board. A Financial Risk Rating of Green was noted, together with an Amber/Green Governance Risk Rating. This related to the performance of A&E during the final quarter of the year. With regard to Financial Risk Triggers, it was noted that this may need to be adjusted to reflect one change in position of Director of Finance in last 12 months. The Trust Board resolved to approve the content of the PMR for submission to the NHS Trust Development Authority. 100/13 MINUTES OF THE QUALITY AND SAFETY COMMITTEE HELD ON 21 MARCH 2013 AND ESCALATION OF ISSUES FROM THE APRIL 2013 MEETING Mr McEvoy presented the minutes of the meeting held on 26 March With regard to the April meeting, he escalated the following matters to the attention of the Trust Board:- HIGH LEVEL OVERVIEW OF ISSUES DEBATED AT THE QUALITY AND SAFETY COMMITTEE, 18 APRIL 2013 PERFORMANCE AND QUALITY REPORT:- In considering the quality indicators in the report the Committee:- Noted the positive year end performance across the majority of quality measures detailed in our Quality and Safety Strategy Noted positive performance relating to HSMR, together with pressure ulcers. Expressed concern relating to some areas of performance in March such as infection control and opened a discussion as to whether capacity pressures during March had compromised performance in this area. Reinforced the need for an independent review of falls prevention and management to understand whether the Trust can improve on its local management of falls. The Director of 25 April 2013 v.1 For One and All 11

12 Nursing advised the Committee that this would be concluded in readiness for the May Committee meeting. QUALITY AND SAFETY COMMMITTEE UPDATE FROM MEETING ON 18 APRIL 2013 The committee met last week and:- Considered a paper from the Director of Nursing relating to End of Life Care and noted progression with the development of associated quality metrics in this area. It was noted that wide patient opinion had been sought regarding the sharing of personal information amongst health agencies to enhance end of life care provision and that this proposal was largely well supported by patients. The Director of Nursing is therefore working with the CCG to establish an appropriate protocol for information sharing. As mentioned earlier, a significant discussion took place regarding the need to establish the threshold when capacity pressures start to impact and create risk on quality and safety measures. The Committee resolved that this needed further debate with the wider Trust Board, but noted that the Chief Executive and Chief Operating Officer are in the stages of finalising the demand and capacity plan for the organisation which may help to inform threshold levels. The Medical Director presented the findings of the recent Deanery inspection. The Committee expressed their concern in relation to the findings, and reaffirmed their commitment to the delivery of improvement actions. The level of risk associated with failing to implement such improvements was considered to be very significant with the possible withdrawal of training status from the organisation. This matter was discussed earlier in the Trust board meeting today, and has been included on the Corporate Risk Register and Board Assurance Framework as a red risk. The Committee has requested that the minutes of the Medical Education Committee are presented to each meeting of the Quality and Safety Committee so that they can monitor improvements in delivery. 101/13 MINUTES OF THE PERFORMANCE, FINANCE AND INVESTMENT COMMITTEE HELD ON 22 MARCH 2013 AND ESCALATION OF MATTERS DEBATED AT THE APRIL 2013 MEETING Mr Summers presented the minutes of the meeting held on 22 March 2013 and drew attention to the discussion relating to Bariatric service future development proposals. With regard to the April meeting, he escalated the following matters to the attention of the Trust Board:- HIGH LEVEL OVERVIEW OF ISSUES DEBATED AT THE PERFORMANCE, FINANCE AND INVESTMENT COMMITTEE HELD ON 19 APRIL 2013 PERFORMANCE AND QUALITY REPORT:- 25 April 2013 v.1 For One and All 12

13 In considering the performance report the Committee:- Congratulated colleagues at all levels of the organisation on the positive end of year performance against key performance indicators, with particular reference to the achievement of the challenging A&E 4 hour standard. Validated results for cancer were positive, together with the delivery of the overall 18 week target. At the end of the year, T&O failed to achieve the incomplete pathways, however the Committee were assured that performance would be achieved from April 2013 Concerns were expressed in relation to the disappointing results associated with the Electronic Discharge summary and the Committee reiterated the need to ensure that a devolved process was in place throughout the organisation to assure on going performance monitoring and effective escalation and validation. Expressed disappointment in the failure of key workforce standards such as appraisal levels and mandatory training levels and received assurance that these would be at target by the end of Q1 2013/14 with sustained performance therafter FINANCE REPORT The Committee commended colleagues on achievement of the financial outturn position and delivery of the cost improvement programme A discussion regarding capital spend in 2012/13 took place as a result of a spend of 4.6M against a budget of 5.5M. It was noted that slippage in spend related to PACS expenditure and a delay of lifecycle works for the Estate. The Committee requested that stronger controls and assurances were put in place for 2013/ /13 ANY OTHER BUSINESS Resignation of Stuart Gray Mr Reid expressed the thanks of the Board and the wider organisation to Stuart Gray for his commitment and contribution as a Non-executive Director on the Board. It was noted that Stuart had submitted his resignation as a Non-executive Director of the Board and that this would take effect from 30 April It was noted that Stuart would continue to work with the Trust with a focus on the governance and management of its charitable funds. 103/13 QUESTIONS FROM THE PUBLIC Mrs Etchells thanked the Board for all of the continuing improvement work that they are delivering to patients across Walsall. 25 April 2013 v.1 For One and All 13

14 Mrs Etchells alerted the Board to concerns that she had relating to a locum consultant s attitude during a recent patient experience. She asked that complaints relating to Dr attitude be addressed due to the lasting damage these can cause to patients. This was noted by the Board. Mr Padgett thanked the Board for the cooperation of staff in working with the public on improving discharge processes and stated that this was helping to improve public understanding and confidence. Ms Perry advised the Board of recent positive and negative experiences incurred by patients at the Manor Hospital. She thanked the Board for the good work that is taking place to improve the culture of the organisation and urged the Board to continually review its progress in this regard. 81/13 DATE AND TIME OF THE NEXT MEETING Thursday 30 May 2013 at 2.00pm in the Lecture Suite, Manor Learning and Conference Centre. 25 April 2013 v.1 For One and All 14